The present invention relates to an assessment technique, which is conveniently practiced on a computer. The computer is either a ‘stand alone’ or connected to a computer network, such as a local area network (LAN) or the world wide web, which is frequently and interchangeably referred to as the Internet. Other devices, including wireless enabled devices, may also be utilized in the assessment technique. Specifically, the present invention relates to a system, method and medium for the assessment of the impact of an ailment on a health related quality of life domain of a patient, where a standardized common metric for comparing the impact of various ailments is established.
In the United States alone, over 100 million people have chronic health conditions, accounting for an estimated $700 billion in annual medical costs. In an effort to control these medical costs, many healthcare providers have initiated outpatient or home healthcare programs for their patients. The potential benefits of these programs are particularly great for chronically ill patients who must treat their diseases on a daily basis. However, the success of these programs is dependent upon the ability of the healthcare providers to monitor their patients remotely in order to avert medical problems before they become complicated and costly.
Various surveys for assessing health and impact of a particular disease are available, but there is no standardized common metric for comparing the impact of various ailments. Although the disease-specific tools, aimed at assessing the impact of a particular disease on HRQOL, have certain sensitivity and specificity aspects, unfortunately they do not possess the ability to compare results across diseases. This inability makes it harder to build a body of results that could help interpretation of the meaning of specific scores.
SF-36 Health Survey-Manual & Interpretation Guide, written by John H. Ware, Jr., Ph.D. et al., and published by The Health Institute, New England Medical Center, Boston, Mass. (copyright, 1993) describes a protocol for an improved health assessment and evaluation technique. The guide includes a thirty-six question survey, which is useful in assessing general health variables. Many have cited the thirty-six question survey as providing excellent results notwithstanding its brevity as compared to other surveys.
“Dynamic Health Assessments: The Search for More Practical and More Precise Outcomes Measures” by John E. Ware, Jr., Jakob Bjorner and Mark Kosinski, (inventors of the present application) published in the Quality of Life newsletter, No. 21 (January-April 1999) generally discusses a psychometric method for assessing indicia of ideal health status.
An article related to the SF-36 survey is “The MOS 36-Item Short Form Health Survey (SF-36)” by John H Ware Jr., PhD. and Cathy Donald Shelbourne, PhD, published in Medical Care, Vol. 30, No. 6, June 1992.
A further article related to certain computer testing algorithms is described at pages 103-135 of Computer Adaptive Testing-A Primer by Howard Wainer, et al. published by Lawrence Erlbaum Associates, Hillsdale, N.J. 1990.
A further shortcoming in these surveys is that they are often directed towards providing an objective evaluation of a patient and his/her health. This method of evaluation doesn't allow a patient to provide their own feedback as to their own perceived state of health, which can be a significant distinction. Although, the objective evaluation of the patient and his/her health provides the healthcare practitioner or healthcare provider with objective indicia as to the perceived state of the patient's health, it is not necessarily helpful in all instances to the patient in understanding his/her health status or progress during any particular time interval. That is, the objective survey results are not frequently presented in a meaningful fashion to the patient. Rather, many of these surveys are primarily directed to the healthcare provider or healthcare organization. A subjective survey is much more meaningful to the patient in understanding their own health status and progress over any time interval. Healthcare providers/healthcare organizations, however, rarely utilize such subjective surveys, and traditionally favor the objective types of surveys known to the art.
Another shortcoming relating to the systems, methods, and surveys, which are cited above, is the relevant inflexibility of the surveys, which are set out in a standardized form and need to be completed in total by the patient/respondent every time that the survey is taken. Thus, patient/respondent encounters the same burden every time that he or she responds to such survey.
Furthermore, the prior art tests and surveys are non-adaptive. Prior survey results of a patient/respondent, or a group of patients/respondents, do not affect the future surveys that they are given. As such, the later surveys do not provide for differentiation in the health status of a patient.
An additional problem in the prior art surveys is their inflexible modes of administration. The surveys generally consist of either the traditional paper-based type or a computer-based replica of the same. The traditional paper-based versions provide a series of questions on paper sheets or booklets for the patient/respondent. After the patient/respondent completes the survey, the administrators evaluate the responses. While cost effective, the format remains inflexible. In the case of the computer-based surveys, many of the prior art surveys are little more than computer-driven versions of the same paper-based surveys, which provide little or nothing in added flexibility.
A further shortcoming in many of the prior art surveys is that they are unsuited for self-administration by a patient/respondent. In the context of the objective surveys described above, the patient/respondent may be very capable of taking the survey and responding to the questions provided therein, but many of these surveys do not provide an immediate response that is readily understood by the patient/respondent by the conclusion of the survey. Thus, while the “objective” type survey may provide meaningful results to a medical practitioner or a health services organization, it is not particularly adapted as a self-monitoring instrument to a patient or respondent.
Additionally, Related art includes tools for assessing Health Related Quality of Life (HRQOL) which have enabled researchers and clinicians to better understand the impact of disease from the patient's perspective (Ware J E, Jr. (2003). Conceptualization and measurement of health-related quality of life: comments on an evolving field. Arch. Phys. Med. Rehabil., 84, S43-S51; and McHorney C A (1997). Generic health measurement: past accomplishments and a measurement paradigm for the 21st century. Ann Intern Med, 127, 743-750, which are incorporated herein by reference in their entirety). Such understanding is particularly important for the treatment of chronic diseases prevalent in the aging population. Evaluating the impact of disease on the HRQOL of the elderly person, for example, is a key element in treatment evaluation, monitoring of patients and screening for potential problems.
Such evaluation of the impact of disease on HRQOL has been performed with two distinct sets of questionnaires: generic and disease-specific. In general, disease-specific measures demonstrate greater sensitivity (Kantz M E, Harris W J, Levitsky K, Ware J E, Jr., & Davies A R (1992). Methods for assessing condition-specific and generic functional status outcomes after total knee replacement. Med Care, 30, MS240-MS252; and Bombardier C, Melfi C A, Paul J, Green R, Hawker G, Wright J et al. (1995). Comparison of a generic and a disease-specific measure of pain and physical function after knee replacement surgery. Med. Care, 33, AS131-AS144, which are incorporated herein by reference in their entirety) and specificity than generic measures (Kantz et al., 1992) while generic measures better capture the total burden of disease (Ware J E, Jr. (1995). The Status of Health Assessment 1994. Annu Rev Public Health, 16, 327-354, which is incorporated herein by reference in its entirety; Bombardier et al., 1995). In the presence of comorbid conditions, generic measures reflect the combined effects of primary and comorbid conditions, whereas disease-specific measures reflect mainly the primary disease (Kantz et al., 1992). Further, generic questionnaires can be used with different diseases and thus allow comparison of disease burden across diseases. Thus, when assessing patients the researcher or clinician needed to use both types of questionnaires or had to make a choice between the generalizability of the generic questionnaire and the sensitivity and specificity of the disease-specific questionnaire.
Therefore, it is desirable to have a single assessment tool, and related method, that can assess the impact of various diseases on HRQOL. It is also desirable to have a system which scores everyone on a standard metric so that the results of various different diseases can be compared. Accordingly, there is a real and continued need in the art for improved systems and methods for the monitoring and assessment of impact of various diseases on HRQOL.
It is appreciated that these are but representative of certain needs in the art which various aspects of the present invention address and provide.